1658 VITAL STATISTICS.

experienced from the inability to find accommodation for thepatients seeking admission to the hospitals. Many of thosefor whom accommodation was sought were without properlodging and accommodation in their own homes; indeed,some of these homes had actually been condemned as unfitfor human habitation. About 12,000 people are at presenthoused in cellars. The requirements of the LiverpoolImprovement Act of 1871 and of the Public Health Act of1875 are very stringent in relation to cellar dwellings andany person who lets or suffers to be occupied any cellar incontravention of these requirements is liable to a penalty notexceeding 910. Proceedings for the abatement of nuisancescaused by the excessive emission of smoke from factorychimneys or from steamers were taken under the LiverpoolSanitary Amendment Act, 1854, Sections 24 and 25, and theLiverpool Improvement Act, 1882, Section 77, with the fol-lowing results : in the case of manufactories 527 reports, inthe case of steamers in the river 305 reports, and in thecase of steamers in dock 71 reports, making a total of 903,as against 943 in 1897. The total fines enacted for theseoffences amounted to .S1182 lls.1d., as against .61138 15. 3d.in 1897. The large and increasing amount paid in fines forsmoke nuisances caused by defective house flues and fromlow chimneys indicates the necessity for care in preventingthem. The birth-rate in the city of Liverpool was excep-tionally high. During the last 10 years the mean has been34’4 per 1000, which is considerably in excess of most of the35 great towns. During the 52 weeks of the year 1898 thereturns of the local registrars recorded 22,227 births withinthe city, making the total birth-rate of the city equal to 33’2per 1000 of the population. Of the total births 11,337 weremales and 10,890 were females.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6627 births and 3591deaths were registered during the week ending June 10th.The annual rate of mortality in these towns which hadbeen 16’0 and 17’7 per 1000 in the two preceding weeksdeclined again last week to 16-4. In London the rate was15’7 per 1000, while it averaged 16’9 in the 32 provincialtowns. The lowest rates in these towns were 10’8 inWest Ham, 11’0 in Norwich, 11’4 in Croydon, and 13’2in Gateshead ; the highest rates were 20’8 in Oldhamand in Sunderland, 20’9 in Liverpool, 21-0 in Salford,and 22-9 in Manchester. The 3591 deaths included 397which were referred to the principal zymotic diseases,against 358 and 386 in the two preceding weeks ; ofthese 162 resulted from measles, 79 from whooping-cough,62 from diphtheria, 42 from diarrhcea, 27 from "fever" "

(principally enteric), 23 from scarlet fever, and two fromsmall-pox. No death from any of these diseases was

recorded last week in Norwich; in the other towns theycaused the lowest death-rates in Croydon, Derby, Halifax,and Gateshead, and the highest rates in Swansea, Bolton,Manchester, and Salford. The greatest mortality frommeasles occurred in London, Nottingham, Bolton, Liver-pool, Manchester, and Salford ; and from whooping-cough inPlymouth, Leicester, Oldham, Huddersfield, and Hull. Themortality from scarlet fever and from "fever" showed nomarked excess in any of the large towns. The 62 deathsfrom diphtheria included 28 in London, seven in Swansea,seven in Sheffield, six in Leicester, six in Hull, and three inWest Ham. One fatal case of small-pox was registered inLondon and one in Hull, but not one in any other ofthe 33 large towns; and only one small-pox patientwas under treatment in the Metropolitan AsylumsHospitals on Saturday last, June 10th. The number ofscarlet fever patients in these hospitals and in the LondonFever Hospital at the end of last week was 2269, againstnumbers increasing from 2161 to 2212 at the end of the threepreceding weeks ; 278 new cases were admitted duringthe week, against 211, 229, and 260 in the three precedingweeks. Influenza was certified as the primary cause of 18deaths in London. The deaths referred to diseases of therespiratory organs in London which had been 256 and 240 inthe two preceding weeks further declined to 216 last weekand were 31 below the corrected average. The causes of 43,or 1’2 per cent., of the deaths in the 33 towns were notcertified either by a registered medical practitioner or bya coroner. All the causes of death were duly certified in

Nottingham, Manchester, Leeds, Newcastle-upon-Tyne, andin 13 other smaller towns. The largest proportions 01uncertified deaths were registered in Birmingham, Leicester,Liverpool, and Blackburn. -

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch townswhich had been 16’9 and 19’9 per 1000 in the two pre-ceding weeks declined again to 18-9 during the week

ending June 10th, but was 2-5 per 1000 above the meanrate during the same period in the 33 large Englishtowns. The rates in the eight Scotch towns ranged from14’1 in Leith and 17 6 in Paisley to 21’3 in Dundeeand 23-7 in Perth. The 576 deaths in these townsincluded 25 which were referred to measles 16 to

whooping-cough, 12 to diarrhoea, six to "fever," fiveto scarlet fever, and two to diphtheria. In all, 66 deathsresulted from these principal zymotic diseases, against 52 and68 in the two preceding weeks. These 66 deaths were equalto an annual rate of 2 2 per 1000, which was slightly abovethe mean rate last week from the same diseases in the 33large English towns. The fatal cases of measles whichhad been 11 and 16 in the two preceding weeksfurther rose to 25 last week, of which 24 occurred inGlasgow. The 16 deaths from whooping-cough correspondedwith the number recorded in the preceding week, and in-cluded five in Leith, four in Edinburgh, four in Glasgow,and three in Dundee. The deaths referred to different formsof "fever" " which had been one and three in the twopreceding weeks further rose to 6 last week, of whichfour occurred in Glasgow and two in Dundee. The fivefatal cases of scarlet fever showed a decline of six from thenumber registered in the preceding week and included fourin Glasgow. The deaths referred to diseases of the respi-ratory organs in these towns, which had been 80 and 108 inthe two preceding weeks declined again to 93 last week andwere 16 below the number in the corresponding period oflast year. The causes of 26, or more than 4 per cent., of thedeaths in these eight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin which had declined in the three

preceding weeks from 26 8 to 22’1 per 1000 rose again to25’2during the week ending June 10th. During the past fourweeks the rate of mortality in the city has averaged 25’2 per1000, the rate during the same period being 16-2 inLondon and 18 2 in Edinburgh. The 169 deaths regis-tered in Dublin during the week under notice showedan increase of 21 upon the number in the preceding week, andincluded 11 which were referred to the principal zymoticdiseases, against seven and five in the two precedingweeks ; of these four resulted from "fever," three fromwhooping-cough, two from scarlet fever, one from diph-theria, one from diarrhoea, and not one either from small-pox or measles. These 11 deaths were equal to an annualrate of 1’6 per 1000, the zymotic death-rate during thesame period being 20 in London and 1’0 in Edinburgh.The four deaths referred to different forms of "fever" ex-ceeded the number recorded in any recent week. Thefatal cases of whooping-cough which had been one andtwo in the two preceding weeks further rose to three lastweek. The mortality from scarlet fever also exceeded thatrecorded in any recent week. The 169 deaths in Dublinlast week included 25 of infants under one year of age and47 of persons aged upwards of 60 years; the deaths bothof infants and of elderly persons exceeded the numbersreturned in the preceding week. Six inquest cases and fivedeaths from violence were registered ; and 67, or more thana third, of the deaths occurred in public institutions. Thecauses of 14, or more than 8 per cent., of the deaths in thecity last week were not certified.

VITAL STATISTICS OF LONDON DURING MAY, 1899.IN the accompanying table will be found summarised

complete statistics relating to sickness and mortalityduring May in each of the 43 sanitary areas of London.With regard to the notified cases of infectious diseasein the metropolis, it appears that the number of personsreported to be suffering from one or other of the ninediseases specified in the table was equal to 7-3 per1000 of the population, estimated at 4,546,752 personsin the middle of this year. In the three preceding

1659

1660 VITAL STATISTICS OF LONDON DURING MAY, 1899.-THE SERVICES.

months the rates had been 8’5, 6’7, and 6’2 per 1000respectively. The rates were considerably below the averagein Paddington, Kensington, St. George Hanover-square, St.Martin-in-the-Fields, Holborn, Whitechapel, and Limehouse ;while they showed the largest excess in St. Saviour South-wark, St. George Southwark, Newington, Bermondsey, Batter-sea, Greenwich, and Plumstead sanitary areas. Three casesof small-pox were notified in London during May, includ-ing one in Fulham, one in Marylebone, and one in Lambethsanitary areas; two small-pox patients were admitted intothe Metropolitan Asylums Hospitals during May, and oneremained under treatment at the end of last month. The

prevalence of scarlet fever in London showed an increaseupon that recorded in the preceding month; among the varioussanitary areas this disease showed the highest proportionalprevalence in Fulham, Stoke Newington, Strand, St. SaviourSouthwark, Greenwich, and Plumstead. The MetropolitanAsylums Hospitals contained 2172 scarlet fever patients atthe end of May, against 2535, 2272, and 2088 at the endof the three preceding months ; the weekly admissionsaveraged 229, against 236, 196, and 177 in the three pre-ceding months. The prevalence of diphtheria in Londonshowed a marked increase upon that recorded in the

preceding month ; this disease was proportionally most

prevalent in Fulham, St. Saviour Southwark, St. GeorgeSouthwark, Newington, Bermondsey, Battersea, Camberwell,and Lewisham sanitary areas. There were 1129 diphtheriapatients under treatment in the Metropolitan AsylumsHospitals at the end of May, against 1388, 1159, and994 at the end of the three preceding months ; the

weekly admissions averaged 152, against 172, 127, and 107in the three preceding months. The prevalence of entericfever in London showed a further decline from thatrecorded in recent months; among the various sani-

tary areas this disease showed the highest proportionalprevalence in St. Luke, Shoreditch, St. George-in-the-East, Greenwich, and Lee sanitary areas. The Metro-

politan Asylums Hospitals contained 99 enteric fever

patients at the end of May, against 215, 148, and 124at the end of the three preceding months; the

weekly admissions averaged 16, against 19 and 17 in thetwo preceding months. Erysipelas was proportionally mostprevalent in Hackney, St. Giles, London City, Shoreditch,Bethnal Green, and Limehouse sanitary areas. The 31 casesof puerperal fever notified in London during May includedfive in Islington, and three each in Paddington, Kensington,Camberwell, and Greenwich sanitary areas.The mortality statistics in the table relate to the deaths of

persons actually belonging to the various sanitary areas of themetropolis, the deaths occurring in the institutions of Londonhaving been distributed among the various sanitary areas inwhich the patients had previously resided. During the fiveweeks ending June 3rd, the deaths of 6873 personsbelonging to London were registered, equal to an annualrate of 15-8 per 1000, against 20-3, 22-2, and 18-0 per 1000 inthe three preceding months. The lowest death-rates in thevarious sanitary areas were 10-1 in Lee, 10-3 in Hampstead,11’0 in Stoke Newington, 11-9 in Battersea, 12-2 in Wands-worth and in Plumstead, and 12-4 in St. George HanoverSquare ; the highest rates were 20-5 in St. Giles, 21’9 inSt. George Southwark, 22-1 in St. George-in-the-East, 22-7 inthe City of London, 24-5 in Limehouse, 26-4 in Holborn, and31-6 in St. Luke. During the five weeks of May 698 deathswere referred to the principal zymotic diseases in London;of these 262 resulted from measles, 30 from scarlet fever, 129from diphtheria, 191 from whooping-cough, 30 from entericfever, 56 from diarrhoea, and not one either from small-pox,typhus, or any ill-defined form of continued fever. These698 deaths were equal to an annual rate of 1-6 per 1000,against 1-6, 1’9, and 1-6 in the three preceding months. Nodeath from any of these zymotic diseases was recordedlast month in St. James Westminster or in St. OlaveSouthwark; in the other sanitary areas they caused thelowest death-rates in St. George Hanover-square, West-minster, Marylebone, St. Giles, Wandsworth, Lee, andPlumstead ; and the highest rates in Holborn, BethnalGreen, St. George-in-the-East, Limehouse, St. GeorgeSouthwark, and Newington. The 262 fatal cases ofmeasles were 128 below the corrected average number inthe corresponding periods of the 10 preceding years; thisdisease showed the highest proportional fatality in Hamp-stead, Hackney, Shoreditch, Bethnal Green, St. George-in-the-East, Limehouse, and Lambeth sanitary areas.

The 30 deaths referred to scarlet fever were less than

half the corrected average number; this disease was pro-portionately most fatal in Bermondsey and Greenwich sani-tary areas. The 129 fatal cases of diphtheria were 50 belowthe corrected average number; this disease showed the

highest proportional fatality in St. Pancras, Clerkenwell,Limehouse, Poplar, Newington, and Bermondsey sanitaryareas. The 191 deaths from whooping-cough were 98 belowthe corrected average number; this disease was pro-portionally most fatal in St. Luke, Limehouse, Mile End OldTown, Poplar, St. George Southwark, and Newington sani-tary areas. The 30 fatal cases of enteric fever were 10below the corrected average number; the mortality fromthis disease showed no marked excess in any of the sanitaryareas. The 56 deaths from diarrhoea were 12 below thecorrected average number. In conclusion, it may be statedthat the aggregate mortality in London during May fromthese principal zymotic diseases was more than 34 psr cent.below the average.

Infant mortality in London during May, measured bythe proportion of deaths of children under one year of ageto registered births, was equal to 110 per 1000. Among thevarious sanitary areas the lowest rates of infant mortalitywere recorded in Chelsea, Marylebone, St. Olave Southwark,Lewisham, Lee, and Plumstead; and the highest rates inWestminster, St. Martin-in-the-Fields, Holborn, City 02London, Limehouse, and St. George Southwark.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.INSPECTOR-GENERAL OF HOSPITALS AND FLEETS HENRY

MACDONNELL, C.B., has been placed on the Retired List.3taff Surgeon Edward Hanbury Williams has been promotedj0 the rank of Fleet Surgeon in Her Majesty’s Fleet.

ROYAL ARMY MEDICAL CORPS.The under-mentioned officers retire on retired pay: Major

Tohn W. Beatty and Major William G. Clements.INDIA AND THE INDIAN MEDICAL SERVICES.

The following appointments are announced :-The services)f Captain A. F. W. King (Bombay), are placed tempo-rarily at the disposal of the Government of Bombay foremployment on plague duty. The services of the under-mentioned officers are placed temporarily at the dis-

posal of the Government of Bengal for employment ODplague duty: Major H. D. Rowan, R.A.M.C., Captain3. J. B. Statham, R.A.M.C., Captain R. W. H. Jackson,R.A.M.C., and Lieutenant W. E. P. V. Marriott, R.A.M.C.rhe services of Major H. E. Deane, R.A.M.C., are placedit the disposal of the Government of Bengal for employmentm plague duty. The services of Captain A. R. S. Anderson;Bengal) are placed temporarily at the disposal of theGovernment of Bengal. The services of Captain W. G.Pridmore (Madras) are placed temporarily at the disposal)f the Government of Burmah. The services of Captain T. A.Granger (Bengal) are placed temporarily at the disposal ofthe Chief Commissioner of Assam. The services of CaptainP. F. Chapman (Bengal) are placed temporarily at the dis-posal of the Chief Commissioner of the Central Provinces.fhe services of Captain W. W. Clemesha (Bengal) are

3laced temporarily at the disposal of the Government ofBengal for employment on plague duty. The services ofjhe under-mentioned officers are placed temporarily at theiisposal of the Government of the North-Western Provincesand Oudh: Captain T. W. A. Fullerton (Bengal) andCaptain C. B. Prall (Bengal).

VOLUNTEER CORPS.

Artillery : 1st North Riding of Yorkshire (WesternDivision, Royal Artillery) : Septimus Farmer to be Sur-;eon-Lieutenant. Rifle: 3rd (Dumfries) Volunteer Battalion,he King’s Own Scottish Borderers : Surgeon-Lieutenant W.Murdoch to be Surgeon-Captain. 2nd Volunteer Battalion,he Gloucestershire Regiment : Surgeon-Captain P. T.unn resigns his commission. 1st Volunteer Battalion theHampshire Regiment : Surgeon-Captain W. K. Loveless’esigns his commission. 2nd Volunteer Battalion theDurham Light Infantry : Surgeon-Lieutenant T. Livingstoneesigns his commission. 5th (Glasgow Highland) Volunteer3attalion the Highland Light Infantry: John McKie to)e Surgeon-Lieutenant. lst (Ross Highland) Volunteer